Brusellozlu hastalarda hepatobiliyer tutulum

Year 2024, Volume: 49 Issue: 4, 1075 - 1081, 30.12.2024

Sibel Yavuz , Merve Kılıç Çil , Ümit Çelik

https://doi.org/10.17826/cumj.1552584

Abstract

Amaç: Bruselloz, dünyada birçok ülkede görülen ve bazı bölgelerde endemik olan bir enfeksiyon hastalığıdır. Bu çalışmada brusella tanısı konan ve tedavisi planlanan çocuk hastalarda hepatobiliyer tutulum sıklığı ve özellikleri araştırılması amaçlanmıştır.
Gereç ve Yöntem: 2022-2024 tarihleri arasında bruselloz tanısı konulup tedavi uygulanan 71 hasta geriye dönük olarak değerlendirildi. Dosya kayıtları incelenerek klinik, demografik özellikleri, laboratuar parametreleri kaydedildi. Hastaların Rose Bengal pozitifliği, Wright aglütinasyon titresi ve kültür sonuçları değerlendirildi.
Bulgular: Hastaların yaş ortalaması 126 ay ve %42,3’si kız, %57,7’si erkek idi. Olguların AST ortanca değeri 61.5 IU/L (14-125), ALT ortanca değeri 71 IU/L (6-256) idi. Olguların en sık şikayeti kas, eklem ve bel ağrısı iken, en az şikayet kilo kaybı veya baş ağrısı idi. Olgularda en sık normal fizik muayene bulguları saptanırken, patolojik en sık fizik muayene bulgusu artritti. Olguların 22’sinde (%31) ALT yüksekliği, 31’inde (%43.7) AST yüksekliği ve 20’sinde (%28.2) olguda AST ve ALT yüksekliği saptandı. Standart tüp aglutinasyon titresi 1/1280 altında ASTve ALT >40 hasta sayısı 6 iken, 1/1280 ve üstünde hasta sayısı 14 idi. Transaminaz yüksekliği tedavi sonrası normale döndü. 8 (%11.2) hastada hepatomegali, 2(%2.8) hastada splenomegali saptandı.
Sonuç: Bruselloz birçok sistemi etkileyip, klinik bulgular farklı olabilir. Eşlik eden hepatolojik tutulumun sık görülmesi nedeni ile transaminaz yüksekliği, hepatomegali ve splenomegalinin ayırıcı tanısında bruselloz mutlaka akılda tutulmalıdır.

Keywords

Bruselloz, çocuk, hepatobiliyer tutulum

Ethical Statement

Ethical approval was obtained from the Clinical Research Ethics Committee of Adana City Research and Training Hospital (15.02.2024/No: 3180). The study was conducted in accordance with the principles of the Declaration of Helsinki.

Supporting Institution

We have no conflicts of interest to disclose. Any specific grant was not received for this research from funding agencies in the public, commercial, or not for profit sectors.

Hepatobiliary involvement in patients with brucellosis

Abstract

Purpose: Brucellosis is a common infectious disease in many countries worldwide and endemic in some regions. This study aimed to investigate the frequency and characteristics of hepatobiliary involvement in pediatric patients diagnosed with and treated for brucellosis.
Materials and Methods: A total of 71 patients who were diagnosed with brucellosis and received treatment between 2022 and 2024 were retrospectively evaluated. Clinical and demographic characteristics, along with laboratory parameters, were collected through a review of the patients' medical records. Rose Bengal test positivity, Wright agglutination titers, and culture results were reviewed.
Results: The mean age of the patients was 126 months. Of the patients, 42.3% were females and 57.7% were males. The median aspartate aminotransferase (AST) value was 61.5 IU/L (range: 14-125), and the median alanine aminotransferase (ALT) value was 71 IU/L (range: 6-256). The most common complaints were myalgia, arthralgia, and low back pain, while weight loss and headache were the least frequent symptoms. In terms of physical examination findings, the majority of cases showed normal results, with arthritis being the most common pathological finding. Among the patients, 22 (31%) had elevated ALT levels, 31 (43.7%) had elevated AST levels, and 20 (28.2%) had elevated levels of both AST and ALT. Of the patients (n=20) with AST and ALT levels of >40 IU/L, the standard tube agglutination test (STAT) titer was below 1/1280 in 6 patients and ≥1/1280 in 14 patients. Elevated transaminases returned to normal in all patients after treatment. Hepatomegaly or splenomegaly was detected in 8 (11.2%) and 2 (2.8%) patients, respectively.
Conclusion: Brucellosis affects multiple organ systems, and its clinical manifestations can vary widely. Due to frequent occurrence of hepatobiliary involvement in brucellosis, brucellosis should always be considered in the differential diagnosis of elevated transaminases, hepatomegaly, and splenomegaly.

Keywords

Brucellosis, Child, Hepatobiliary involvement

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